Carotid Artery Disease

with Andrew Brooks, M.D., General and Vascular Surgery, Advanced Healthcare

Posted: May 1, 2004

The carotid arteries are the main blood vessels to the brain. These arteries, located in the neck, can develop a build-up of plaque caused by arteriosclerosis, or hardening of the arteries. When plaque in the carotid arteries becomes very severe, a stroke can occur.

Who is at risk for carotid artery disease?
Dr. Andrew Brooks, a general and vascular surgeon with Advanced Healthcare, said there are several risk factors associated with the disease: smoking, high blood pressure, high cholesterol, family history, male gender, and advanced age.

Andrew Brooks, M.D., General and Vascular Surgery, Advanced Healthcare "You may not be able to change some of your risk factors, such as your gender or family history, but you can change the others. Cessation of smoking is very important in the prevention of carotid artery disease."

“You may not be able to change some of your risk factors, such as your gender or family history, but you can change the others. Cessation of smoking is very important in the prevention of carotid artery disease,” Dr. Brooks said.

What is a stroke?
A stroke occurs when blood flow is cut off from part of the brain. The most common type of stroke is an ischemic stroke, which is caused by a blockage of blood flow in an artery in the head or neck leading to the brain. Some ischemic strokes are due to stenosis, or narrowing of the arteries due to the build up of plaque, fatty deposits and blood clots along the artery wall.

How can I prevent this?
Regular visits to your primary care physician are important for people who have any of the risk factors for carotid artery disease. “Primary care physicians and internal medicine doctors are best able to manage the risk factors for carotid artery disease,” Dr. Brooks said. “We consider them the specialists in managing high blood pressure and high cholesterol.”

What are the symptoms of carotid artery disease?
A “symptomatic” patient who has carotid artery disease may exhibit some of the symptoms related to strokes — in fact, these symptoms are miniature strokes. He or she may have a focal area of weakness on one side of the face, slurred speech or loss of vision on one side. “Sometimes people say it looks like someone pulled down a shade on one half of their vision,” Dr. Brooks said.

He cautioned however, that many people who have carotid artery disease are asymptomatic. A patient may feel fine, but in examining the patient, a doctor may hear through the stethoscope a “bruit,” or extra sound heard in one artery. This is often a telltale sign of carotid artery disease.

In the cases of both symptomatic and asymptomatic patients, the doctor is likely to recommend a screening ultrasound.

What tests will I need to go through?
If the screening ultrasound reveals a significant degree of narrowing of the arteries, the doctor will order confirmatory tests.

The most common type of test is the Magnetic Resonance Angiography (MRA). This is a method of producing extremely detailed pictures of body tissues and organs without the need for X-rays. In a MRA, a computer forms two- or three-dimensional images of blood vessels that may be viewed on a TV monitor.

Other possible tests include the Computed Tomography Angiography (CTA) and an interventional angiogram.

How is carotid artery disease treated?
Dr. Brooks stressed that any treatment of carotid artery disease is designed to lower future risk of stroke. “Hopefully, the person has had a good recovery if he or she had any miniature strokes in the past. The treatment is to prevent a more serious stroke from occurring.”

Depending on where the artery is narrowed and the risk level of the patient for surgery, a doctor will recommend medication, surgery or a combination of the two. A carotid endarterectomy is a surgical procedure in which a doctor removes plaque blocking one of the two carotid arteries.

Aspirin and Coumadin are two blood-thinning agents many patients with carotid artery disease take.

A treatment currently under study for use in carotid artery disease treatment is stenting. This is generally reserved for patients who would not be good candidates for surgery.

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